Provider Demographics
NPI:1851751929
Name:RIEDEL, REBECCA (LPCIT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:LPCIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GISHOLT DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4835
Mailing Address - Country:US
Mailing Address - Phone:608-223-1506
Mailing Address - Fax:
Practice Address - Street 1:6400 GISHOLT DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-4835
Practice Address - Country:US
Practice Address - Phone:608-223-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional